Top 7 Rants on Exercise

In general, I will say that movement is good.  For example, if all you can do is walk 20 minutes a day at lunch, then that is better than not exercising at all.  However, in my experience, I have heard a lot of excuses or false reasonings on why someone having a musculoskeletal problem doesn’t need advice on exercise.

  1. “I don’t need to work out because I work hard at my job.”  Exercise is different than work.  At work, you are focused on completing a task.  You don’t have the time to focus on how you move or what muscles you are using.  Exercise is when you can focus on yourself, how you move, and what muscles you are using.
  2. “I don’t have time to workout.”  The American College of Sports Medicine recommends 1.5 hours of exercise a week.  There are 168 hours in a week.  That is less than 1% of hours available in a week.  This is the equivalent of a little over 20 minutes a day.  That could be a lunch break at work, before work (my preference), or a family walk after dinner.
  3.  “I can’t afford a gym membership.”  Did cavemen have a gym?  No.  I am a huge believer that exercise should be accessible to everyone.  That is why I design exercises that can be done without extensive exercise equipment.  Walking and running is free.  So are pushups, burpees, step-ups, etc.  In fact, if you have a chair, you can exercise most major muscle groups with this article.  
  4. “Exercise machines are better and safer.”  This myth came out of the thought that exercise machines can isolate muscle groups are strengthen them more efficiently without increasing your risk of injury.  In fact, most experts now propose functional exercise (exercise that emulates the way that we move in real life) because we do not do tasks with a single muscle group.  We need to train muscle groups to work together so that when we do a demanding activity in real life, the muscles have “seen” this similar movement during exercise and can say “oh yeah, I know how to do this”, and get the job done.  Also, exercise machines do not decrease the risk of injury.  In fact, many machine exercises put the person in a sitting position which is known to put excessive stress on the spine and increase your risk of injury.
  5. “NO PAIN, NO GAIN!”  THIS IS THE WORST! This myth comes from the idea that it must hurt to break down muscles in order to build stronger muscle.  First, although exercising muscle to fatigue can accelerate the build up of new muscle, given adequate recovery time, however, pain is not the same thing as fatigue.  I know of no research that shows pain is needed to build muscle.  Second, this gives the exerciser the false expectation that they must feel pain in order to get stronger.  In fact, pain can be a warning sign that you are injuring tissue, like a disc in your spine; and when patients are new to exercise, they are often times afraid of pain (who isn’t?) and so hearing this oft quoted phrase scares them away from the much need rehabilitative exercise program that will help them, ironically, out of their pain.
  6. “Physical therapy doesn’t work for me.”  This myth often comes from past experiences when patients have experienced physical therapy only involving electrical stimulation, TENs stimulation, therapeutic ultrasound, heat packs, ice packs, etc. This feels good temporarily but wears off after you remove the treatment. We call this “Shake & Bake” shops.  None of these treatments do anything for chronic low back pain and if a clinic is only offering this, that is a warning sign that you need to find a new clinic.  Physical therapy is great for showing a patient how to start an exercise program that works on increasing your flexibility and strength, without increasing pain.  If you have difficulty, they can show you ways to personalize exercises for you.  They may utilize some modalities (listed above), along with massage, manipulation, traction, etc, but all this is geared towards helping you tolerated rehabilitation exercise.  In short, who treats you is more important than what they treat you with.
  7. “Just give me a list of exercises to do.” For the most part, no exercise program is dramatically better than another, especially today when there are so many options: pilates, yoga, CrossFit, P90X, Zumba, etc.  Research shows that none of these programs are more risky at causing injury than another program.  However, I view exercise programs as tools. Some tools work better for some jobs than others. Furthermore, not all exercise programs are good for everyone.  For example, when you have an injury, you need to find the right exercise that works for you; this often takes some trial and error to find an exercise that targets the right muscles without causing pain (see #5).  That is why a standard exercise sheet doesn’t work, especially in people recovering from an injury.

Well, that is enough ranting for now.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life

Dr Ethan Colliver

 

 


Muscle & Bone Health in Aging

The muscle and bone systems are constantly changing and reacting throughout our lives; and the effects are different for men and women, but remarkably similar. Both muscle and bone will undergo a normal decline as we age; somewhere around the age of 25 in men.  Muscles lose strength and power for various reasons:

1. muscles lose mass: there is a decrease in muscle fiber size and a decrease in muscle fiber quantity, starting at the age of 25, due to decreases in estrogen, testosterone, and Insulin-like Growth Factor-1 (IGF-1).
2. loss of motor units: the number of motor nerves that innervate muscle cells decreases
3. less muscle protein synthesis
4. loss of aerobic capacity: this is multifactorial in itself
5. loss of synchronization of the firing of motor units: also, multifactorial, such as with prior sciataca or disc herniation

Bones lose mass as we age because of several reasons:
1. loss of sensitivity of bones to muscle: loss of testosterone, IGF-1, and estrogen decreases bone response to mechanical stimulation by muscles and result in loss of muscle mass.
2. loss of muscle mass, area, and strength: due to loss of IGF-1, estrogen, and testosterone and this loss of muscle can also decrease the stimulation on bones.
3. increased bone resorption: due to loss of estrogen and testosterone

You can counteract this decline in bone and muscle health with strength and endurance training. Regular strenuous exercise (20-60min, 3-5 days/week)increases muscle strength and power, aerobic capacity, and bone density. Currently, no medications are approved for the treatment of muscle loss that occurs with aging and some treatments, including testosterone, can have dangerous side effects. For bone loss, exercise can increase the stimulation on bones by muscles and improve power and balance to decrease your risk of falls. Many medications exist for treating thin bones, including testosterone in men, but it appears that exercise can be as effective and both treatments should be implemented.

If you are concerned about your bone and muscle health, you should check with your doctor to see if an underlying medical condition is present, or if this a natural process with aging. Your doctor may prescribe medications and exercise to treat your issues.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life

Dr Ethan Colliver

 


Ouch! My Neck Hurts!

Bicycling is a great non-impact sport that can be enjoyed by many, no matter the age.  I have been an avid bicyclist since I was a resident physician at the University of Utah.  When I started commuting to work, my low back pain improved, as did my overall health and endurance.  I loved the alone time and the beautiful scenery I would otherwise  miss if I drove to work.

After a few years I developed neck pain.  I tried switching bikes and used a bike rack instead of a backpack, but to no avail.  Neck pain is a common complaint

for bicyclists and affects up to 50% of regular cyclists.

When you ride a traditional bike, the rider leans forward to grasp the handlebars and this increases the kyphosis (or flexion) of lumbar and thoracic spine and hyperextends the neck.  This results in overloading of the small joints in the neck and the paraspinal muscles that hold the head up.  Hyperextension of the neck can also cause pinching of the nerves from the neck to the arms, thereby causing arm pain, numbness, and tingling.  If a rider has poor midback flexibility and strength, then the upper neck muscles (upper trapezius, levator scapulae, scalenes, sternocleidomastoid) can become overactive and put additional stress on the neck.  Dr. Janda, a renowned neurologist, referred to this as “upper crossed syndrome”.

Treatment must address appropriate exercise and proper bike fitting.  Cross-training is essential to work on antagonistic muscles and movements to oppose the sustained posture of bicycling. In my case, I should have strengthened my deep neck flexors and mid-back muscles and worked on flexibility of the anterior and upper neck muscles.

I recently took advantage of a professional bike fitting service at a local bike shop, East Coasters.  I saw a dramatic difference in my posture and neck pain while on my bike immediately after the fitting.  At East Coasters, the athlete is carefully measured and examined while on a bike in order to ensure proper seat height, arm elevation and reach, and other factors.

Neck pain that lasts more than a month or results from trauma should be a red flag to go see a doctor for further evaluation.  Severe cases may require a neck injection, manipulation, or even surgical consultation.

Good Luck!

Valley Sports & Spine Clinic

Giving you Back your Life

Dr. Ethan Colliver

 

 

 


Your back hurts… because of your ankle!

No, I am not disregarding the earlier post about toilets. Let me explain. After my freshman year in college, I worked as a housepainter for two weeks. That career choice came to a screeching halt after I fell off a roof and shattered multiple bones including my left ankle. I now have a very stiff, arthritic ankle. It doesn’t even dorsiflex to neutral. In my twenties, I began having back pain and didn’t know why. I was sedentary but thin and very busy with my medical training.  I eventually realized that I had a lumbar disc herniation with occasional right leg pain. Why?

Disc herniations  happen when you have excessive flexion or twisting through a disc.  We bend over more than a thousand times a day which requires squatting.  Squatting requires full hip flexion, knee flexion, and ankle dorsiflexion.  The picture below shows a natural full squat with a lot of ankle dorsiflexion.

lady squattingNotice her degree of ankle dorsiflexion. Also, note how upright her lumbar spine is.  Her upper body is leaning on her thighs thus taking the stress off the lumbar spine which is in essence “hanging” from  her thoracic spine and not taking any significant torque.

Below is an example of a Western squat, in which the person comes up on their toes in order to get down.

Note her degree of ankle dorsiflexion.  Also, note how perpendicular her spine is to being upright.  This creates more torque on the lumbar discs than the upright posture and thus more stress on the discs.

I believe taking the weight off the heels leads to increased calf muscle activity, which leads to hamstring overactivity and inhibition of the hip muscles (ie- gluts), which lead to overactivity of lumbar paraspinal muscles and increased stress on lumbar spine.  This aligns with the work of the great Neurologist, Dr Janda.

 

 

In the above picture on the left, lack of ankle flexibility prevents her from squatting further.  If she squats further with same angle in her ankle, then she will have to lean back and thus lose her balance (also, her lumbar spine is now more parallel to the ground and thus more stressed).  In the picture on the right, having a lift under her heels allows her to keep her center of balance forward (and her lumbar spine more upright) and do a deeper squat.  This is a happier lumbar spine!

In short, healthy backs require full range of motion and strength of the whole chain.  From the lumbar spine, pelvis, hips, knees, ankles and feet.  When you have back pain, the whole system must be assessed.  The back pain is often a result of a problem elsewhere in the chain.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

 


What is your Fitness Age?

Here is a video featuring a colleague of mine who is the Director of Sports Medicine at Columbia University.  video on Fitness Age

The fitness calculator can be found here : Fitness Calculator

It was eye-opening to calculate my “Fitness Age”, which was 25.  Not bad, considering my 4 kids and full time practice make me feel 55, at times. … but I know I can do better.

I was discussing with our Physician Assistant, Holly, how I would rather sleep in every morning in stead of waking up at 5:30am to exercise.  Those extra 10 minutes in bed often will lead to 20, 30, …. oops, got to go to work. But, it is amazing how just after a few minutes of exercising I can say “This feels good.  I needed this.”

I workout 3-4 days a week now but I could improve by exercising 5-6 days a week.  It could be hikes with my family or biking to work in stead of driving. What could you do?  It does not have to be a fancy.  In fact, you don’t need any gym.  One trick, if you have kids, is to make up silly “races” back and forth in your living room: crab walks, bear crawl, hopping, skipping, etc.  Everyone has fun and you get your exercise.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

 

 


Owww…. My disc hurts!

One of the most common causes of low back pain is lumbar disc pain.  The disc has an outer layer made up of cartilaginous (annulus fibrosus) layers surrounding a gel-like center (nucleus pulposus). There is one disc between each bony vertebral level in our low back.  According to Stuart McGill, PhD, it behaves more as a ball-bearing joint than a “shock absorber” (that is for a later topic).  The anatomy allows us to bend our low backs with great flexibility in all directions. The outer third of the disc is innervated by sinu vertebral nerves, meaning that it can transmit pain signals coming from the low back.  The annulus fibrosus is thinnest near to where the nerves to our legs are traveling in our spinal canal.

A disc injury is a tearing of the outer layer allowing the inner gel to work its way to the outside of the disc. The tearing and subsequent leakage of disc material causes a lot of inflammation in the spinal canal. This inflammation can cause back pain, muscle spasms and irritate the nerves to the leg, causing leg pain. If the disc material causes pressure and compression of the nerves of the legs, this can lead to weakness.

Stuart McGill PhD showed that the lumbar disc material can herniate through the outer layer (annulus fibrosus) in as little as 20,000 repetitions of forward flexion or twisting through the lumbar spine. It is unlikely to cause a disc herniation if you bend backwards or sideways. Stooping, sitting, and bending at the waist are causes of disc herniation and subsequently back or leg pain.

His research also has shown that humans will bend forward over 1,000 times a day and backwards only 150 times a day. With this in mind, it is easy to see how we can cause a disc herniation just by doing our day-to-day routines. However, we move in ways that are safe for our discs, such as backwards, very rarely. Therefore, WE CAUSE LOW BACK PAIN BY THE WAY WE MOVE!

There is good news. Proper lifting mechanics can decrease your risk of lumbar disc herniations and back pain. For example, professional weightlifters lift extreme amounts of weight in a squatting position and you find that they do not get disc herniations more frequently than the general population. Why is this? They have proper strength and flexibility within their core, pelvis, and in their hips.

 

Most treatments for low back pain are reactive, meaning that treatment is started after someone is already experiencing back pain.  Most treatments do not decrease your risk of future back pain. Research shows that the only thing to decrease your risk of future low back pain is exercise. So again I encourage you to get into that exercise program and if you have pain with exercise, ask for help from a physical therapist and physician.

Good luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

 


Your back hurts because you’re pooping wrong!

Low back pain in Western society is very common.  Studies suggest up to 90% of Americans will have an attack of back pain and 26.4% have had back pain in the past 3 months.  Koreans have a lifetime chance of around 60% and 15% chance of having back pain in the past year.  Why the difference?  Squatting may be one of the most important things for your back pain and your health, and American toilets don’t let us do it.

 

Western toilets became common the late 19th century.  Prior to that, most people would squat to eliminate, over time sitting became a sign of being “civilized”.  With that change came a decrease in communicable disease like cholera but also brought new diseases like appendicitis, hemorrhoids, and back pain.

One of the best treatments for preventing back pain is proper exercise.  Exercise should focus on flexibility and strength training.  A full squat requires full hip flexibility and great hip, pelvic, and core strength to perform properly.  Asian or squat toilets require the user to perform a full squat to eliminate.  Now, if the average person uses the bathroom 4-7 times a day, that is an opportunity to do a great exercise for your back and health 4-7 times a day.  Further benefits may include decreased constipation, hemorrhoids, diverticulitis, appendicitis, and possibly colon cancer.

asian squat

You can take advantage of a squatting toilet without spending $1000 to install one in your house.  I recommend two products: Squatty Potty for a beginner and a Squat Platform for an advanced full squatter.

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

 

 


Stick with that new exercise program!

With New Years Resolultions abounding, lets discuss how to stick to a resolution to start exercising!  Naomi Beinart, BSc Psych, presented a recent review in The Spine Journal (December 2013, Volume 13, Number 12) of all the current research looking at this question.  According to Beinart, between 50-70% of patients with chronic low back pain stop their home exercise program, despite knowing that exercise is a major way to treat low back pain.

Here are some positive factors in predicting the continuation of an exercise program:

1. If you believe you have control over your health, and your back pain, you are more likely to keep exercising.

2.  Actively develop your own exercise program.  If you work with a personal trainer, or Physical Therapist to design a program specific to you and your needs, you are more likely to succeed.

3. Working with a health care provider or therapist while exercising  increases your success rate!

4. Psychological counseling to work on self-motivation will help you succeed.

In summary, the more you believe that you control your health, help develop your own exercise routine, and have supervision while exercising, the more likely you are to keep your exercise program and your New Years Resolution.  Some people may benefit from counseling to help motivate themselves.

For supervision, you can try working out with a friend who has lots of experience, or perhaps sign up for weekly sessions with a personal trainer.  Another option may be to enroll in an exercise class at a local community rec center.  If you have persistent significant pain with exercise, seek medical help.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver


Sitting is Bad for Your Health | Valley Sports & Spine Clinic

Having a regular exercise routine is important; but, how much time you spend sitting throughout the day may be just as important.  A British Journal of Sports Medicine article in 2009 correlates total sitting time in a day to “an increase risk of type 2 diabetes, heart disease, and other prevalent chronic health problems- even if you exercise regularly.”  Research now suggests being active throughout the day, whether you like lawn care, gardening, hunting or fishing, for example, reduces your risk for cardiovascular disease and other chronic health conditions.

Long periods of sitting leads to a lack of muscle contractions and decreased blood flow.  Dr Vernikos, former NASA specialist, conducted research that supports getting up from sitting around 35 times a day to reduce your risk of cardiovascular disease.  The author of the cited article suggests setting a timer to remind you to stand up and move every 15 minutes.

Sitting with poor posture increases stress on your discs in your low back.  This is a common cause of back pain.  If you have a herniated disc, you may find sitting to be intolerable.  Avoid sitting for more than 15 minutes and avoid long car rides, as both will aggravate a disc injury.

To read more about prolonged sitting and your health, check out:
The Importance of Intermittent Movement For Longevity, by Dr. Mercola

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver